Provider Demographics
NPI:1245369172
Name:WILLIAMSON, MARK KEVIN (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:KEVIN
Last Name:WILLIAMSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 MAIN ST.
Mailing Address - Street 2:PO BOX 213
Mailing Address - City:BRITTON
Mailing Address - State:SD
Mailing Address - Zip Code:57430-0213
Mailing Address - Country:US
Mailing Address - Phone:605-448-5977
Mailing Address - Fax:
Practice Address - Street 1:701 MAIN ST.
Practice Address - Street 2:
Practice Address - City:BRITTON
Practice Address - State:SD
Practice Address - Zip Code:57430-0213
Practice Address - Country:US
Practice Address - Phone:605-448-5977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM6121223G0001X
ND17451223G0001X
MN93051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice